Department of Orthopedic Surgery, University of California, Los Angeles, Santa Monica, California.
David Geffen School of Medicine, University of California, Los Angeles, Los Angeles, California.
J Knee Surg. 2022 Nov;35(13):1409-1416. doi: 10.1055/s-0041-1723979. Epub 2021 Feb 22.
There is currently a paucity of data regarding the potential relationships between preexisting spinal deformity and clinical outcomes following total knee arthroplasty (TKA). We sought to expand upon this deficit. We hypothesize that lumbar sagittal mismatch deformity (MD) will correlate with a decrease in functional outcomes after TKA. This retrospective cohort comparison of 933 TKAs was performed between January 2017 and 2020. TKAs were excluded if they were not performed for primary osteoarthritis (OA) or if preoperative lumbar radiographs were unavailable/inadequate to measure sagittal parameters of interest: pelvic incidence, sacral slope, pelvic tilt, lumbar lordosis, and deformity mismatch. Ninety-four TKAs were subsequently available for inclusion and divided into two groups: those with MD as defined by |PI-LL| > 10 degrees and those without MD. The following clinical outcomes were compared between the groups: total postoperative arc of motion (AOM), incidence of flexion contracture, and need for manipulation under anesthesia (MUA). In total, 53 TKAs met the MD criteria, while 41 did not have MD. There were no significant differences in demographics, body mass index, preoperative knee range of motion (ROM), preoperative AOM, or opiate use between the groups. TKAs with MD were more likely to have MUA ( = 0.026), ROM <0 to 120 ( < 0.001), a decreased AOM by 16 degrees ( < 0.001), and a flexion contracture postoperatively ( = 0.01). Preexisting MD may adversely affect clinical results following TKA. Statistically and clinically significant decreases in postoperative ROM/AOM, increased likelihood of flexion contracture, and increased need for MUA were all noted in those with MD. This is a Level 3 study.
目前，关于术前脊柱畸形与全膝关节置换术（TKA）后临床结果之间的潜在关系的数据很少。我们试图对此进行扩展。我们假设腰椎矢状面不匹配畸形（MD）与 TKA 后功能结果的下降相关。本研究回顾性比较了 933 例 TKA，时间为 2017 年 1 月至 2020 年。如果 TKA 不是因原发性骨关节炎（OA）引起的，或者术前腰椎 X 线片无法获得或不足以测量感兴趣的矢状参数：骨盆入射角、骶骨斜率、骨盆倾斜度、腰椎前凸和畸形不匹配，则排除 TKA。随后有 94 例 TKA 可纳入研究并分为两组：定义为|PI-LL|>10 度的 MD 组和无 MD 组。比较两组之间的以下临床结果：总术后运动弧（AOM）、屈曲挛缩发生率和需要在全身麻醉下进行手法复位（MUA）。总共有 53 例 TKA 符合 MD 标准，而 41 例 TKA 没有 MD。两组在人口统计学、体重指数、术前膝关节活动度（ROM）、术前 AOM 或阿片类药物使用方面无显著差异。MD 组更有可能进行 MUA（ = 0.026）、ROM <0 至 120（ < 0.001）、AOM 减少 16 度（ < 0.001）和术后出现屈曲挛缩（ = 0.01）。术前 MD 可能会对 TKA 后的临床结果产生不利影响。在 MD 组中，所有患者术后 ROM/AOM 显著降低、发生屈曲挛缩的可能性增加以及需要 MUA 的可能性增加。这是一项 3 级研究。
